Your survey response will be used to help LACDMH improve its planning and implementation of this pilot project. You may also email your feedback to Deputy Director Mimi Martinez McKay at MMMcKay@dmh.lacounty.gov.

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1.What do you see as strengths of the proposal?

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2.What do you see as challenges of the proposal?

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3.Is the information in the proposal clearly presented?

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4.Please provide additional feedback about the proposal in the space below.

Demographic Questions (Optional)

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5.What is your affiliation? (Check all that apply)

Client / consumer

Peer

Advocate

Family member of a client / consumer

Other government employee

LACDMH staff / employee

Mental health service provider

Other (please specify)

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6.What is your age?

Under 20 years old

20 to 29 years old

30 to 39 years old

40 to 49 years old

50 to 59 years old

60 to 69 years old

70 years old or over

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7.What ethnic groups do you identify with? (Check all that apply)

African-American / Black

Asian

Caucasian / White

Hispanic or Latino

Mixed / Multi-ethnic

Native American / Amerian Indian / Alaskan Native

Native Hawaiian / Pacific Islander

Other (please specify)

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8.What is your Zip Code?

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9.If you would like us to contact you directly regarding your feedback, please provide your name and email below (optional)